Provider Demographics
NPI:1255341681
Name:WESSING, MISTY (PA-C)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:WESSING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-942-7998
Mailing Address - Fax:
Practice Address - Street 1:1259 RICKERT DR
Practice Address - Street 2:SUITE #200
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8902
Practice Address - Country:US
Practice Address - Phone:630-369-1572
Practice Address - Fax:630-369-6139
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002704363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085-002704OtherSTATE LICENSE